August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 53489014305 SPIRONOLACT TAB 25MG 12/31/9999 20121 53489014310 SPIRONOLACT TAB 25MG 12/31/9999 20121 59762501101 SPIRONOLACT TAB 25MG 12/31/9999 20121 59762501102 SPIRONOLACT TAB 25MG 12/31/9999 20121 63739022610 SPIRONOLACT TAB 25MG 06/30/2012 20121 63739054410 SPIRONOLACT TAB 25MG 12/31/9999 20121 65162051110 SPIRONOLACT TAB 25MG 12/31/9999 20121 65162051111 SPIRONOLACT TAB 25MG 12/31/9999 20121 65162051150 SPIRONOLACT TAB 25MG 12/31/9999 20121 68084020601 SPIRONOLACT TAB 25MG 12/31/9999 20121 00228267211 SPIRONOLACT TAB 50MG 12/31/9999 20121 00228267250 SPIRONOLACT TAB 50MG 12/31/9999 20121 00378024301 SPIRONOLACT TAB 50MG 12/31/9999 20121 00378024305 SPIRONOLACT TAB 50MG 12/31/9999 20121 00378024393 SPIRONOLACT TAB 50MG 03/31/2014 20121 00603576421 SPIRONOLACT TAB 50MG 12/31/9999 20121 00603576428 SPIRONOLACT TAB 50MG 12/31/9999 20121 51079097901 SPIRONOLACT TAB 50MG 12/31/9999 20121 51079097920 SPIRONOLACT TAB 50MG 12/31/9999 20121 53489032801 SPIRONOLACT TAB 50MG 12/31/9999 20121 53489032805 SPIRONOLACT TAB 50MG 12/31/9999 20121 53489032806 SPIRONOLACT TAB 50MG 12/31/9999 20121 53489032807 SPIRONOLACT TAB 50MG 12/31/9999 20121 59762501201 SPIRONOLACT TAB 50MG 12/31/9999 20121 63739054510 SPIRONOLACT TAB 50MG 12/31/9999 20121 65162051410 SPIRONOLACT TAB 50MG 12/31/9999 20121 65162051450 SPIRONOLACT TAB 50MG 12/31/9999 20121 68084020701 SPIRONOLACT TAB 50MG 12/31/9999 20121 50458029001 SPORANOX CAP 100MG 12/31/9999 20121 50458029004 SPORANOX CAP 100MG 12/31/9999 20121 50458029028 SPORANOX CAP PULSEPAK 12/31/9999 20121 50458029515 SPORANOX SOL 10MG/ML 12/31/9999 20121 00555901658 SPRINTEC 28 TAB 28 DAY 12/31/9999 20121 00517888001 SPRIX SPR 15.75MG 12/31/9999 20121 00517888005 SPRIX SPR 15.75MG 12/31/9999 20121 11701015609 SPROAM LIQ 0.1% 12/31/9999 20121 11701015635 SPROAM LIQ 0.1% 12/31/9999 20121 11701015636 SPROAM LIQ 0.1% 12/31/9999 20121 00003085222 SPRYCEL TAB 100MG 12/31/9999 20121 00003085722 SPRYCEL TAB 140MG 12/31/9999 20121 00003052711 SPRYCEL TAB 20MG 12/31/9999 20121 00003052811 SPRYCEL TAB 50MG 12/31/9999 20121 00003052411 SPRYCEL TAB 70MG 12/31/9999 20121 00003085522 SPRYCEL TAB 80MG 12/31/9999 20121 46287000601 SPS SUS 15GM/60 12/31/9999 20121 46287000604 SPS SUS 15GM/60 12/31/9999 20121 46287000660 SPS SUS 15GM/60 12/31/9999 20121 38779026005 SQUALANE OIL 12/31/9999 20121 51552129101 SQUARIC ACID LIQ BUTANOL 12/31/9999 20121 51552129109 SQUARIC ACID LIQ BUTANOL 12/31/9999 20121 52544096728 SRONYX TAB 12/31/9999 20121 43598021025 SSD CRE 1% 12/31/9999 20121 43598021040 SSD CRE 1% 12/31/9999 20121 43598021050 SSD CRE 1% 12/31/9999 20121 43598021055 SSD CRE 1% 12/31/9999 20121 43598021085 SSD CRE 1% 12/31/9999 20121 49884060036 SSD CRE 1% 02/28/2014 20121 49884060040 SSD CRE 1% 03/31/2014 20121 49884060057 SSD CRE 1% 01/31/2014 20121 49884060058 SSD CRE 1% 07/31/2013 20121 49884060085 SSD CRE 1% 01/31/2014 20121 49884060136 SSD AF CRE 1% 07/31/2013 20121 49884060140 SSD AF CRE 1% 01/31/2014 20121 00245000308 SSKI SOL 1GM/ML 12/31/9999 20121 00245000331 SSKI SOL 1GM/ML 12/31/9999 20121 58407009101 STAGESIC CAP 500-5MG 12/31/9999 20121 58407062530 STAHIST AD TAB 25-60MG 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 00078040805 STALEVO 100 TAB 12/31/9999 20121 00078054505 STALEVO 125 TAB 12/31/9999 20121 00078040905 STALEVO 150 TAB 12/31/9999 20121 00078052705 STALEVO 200 TAB 12/31/9999 20121 00078040705 STALEVO 50 TAB 12/31/9999 20121 00078054405 STALEVO 75 TAB 12/31/9999 20121 60258015910 STAN FLUORID CON 0.63% 12/31/9999 20121 00135049902 STANBACK POW HEADACHE 12/31/9999 20121 00135049906 STANBACK POW HEADACHE 12/31/9999 20121 00135049950 STANBACK POW HEADACHE 12/31/9999 20121 11530000202 STANBACK POW HEADACHE 12/31/9999 20121 11530000206 STANBACK POW HEADACHE 12/31/9999 20121 11530000224 STANBACK POW HEADACHE 12/31/9999 20121 11530000250 STANBACK POW HEADACHE 12/31/9999 20121 00078035205 STARLIX TAB 120MG 12/31/9999 20121 00078035105 STARLIX TAB 60MG 12/31/9999 20121 58407012516 STATUSS LIQ GREEN 12/31/9999 20121 00378504091 STAVUDINE CAP 15MG 12/31/9999 20121 31722051560 STAVUDINE CAP 15MG 12/31/9999 20121 59762119001 STAVUDINE CAP 15MG 10/31/2012 20121 65862011160 STAVUDINE CAP 15MG 12/31/9999 20121 00378504191 STAVUDINE CAP 20MG 12/31/9999 20121 31722051660 STAVUDINE CAP 20MG 12/31/9999 20121 59762119101 STAVUDINE CAP 20MG 10/31/2012 20121 65862011260 STAVUDINE CAP 20MG 12/31/9999 20121 00378504291 STAVUDINE CAP 30MG 12/31/9999 20121 31722051760 STAVUDINE CAP 30MG 12/31/9999 20121 59762119201 STAVUDINE CAP 30MG 10/31/2012 20121 65862004660 STAVUDINE CAP 30MG 12/31/9999 20121 00378504391 STAVUDINE CAP 40MG 12/31/9999 20121 31722051860 STAVUDINE CAP 40MG 12/31/9999 20121 59762119301 STAVUDINE CAP 40MG 10/31/2012 20121 65862004760 STAVUDINE CAP 40MG 12/31/9999 20121 68968312501 STAVZOR CAP 125MG 12/31/9999 20121 68968325001 STAVZOR CAP 250MG 12/31/9999 20121 68968350001 STAVZOR CAP 500MG 12/31/9999 20121 00085309904 STAXYN TAB 10MG 12/31/9999 20121 00173082204 STAXYN TAB 10MG 12/31/9999 20121 00113040958 STAY AWAKE TAB 200MG 12/31/9999 20121 00113040973 STAY AWAKE TAB 200MG 12/31/9999 20121 00904795544 STAY AWAKE TAB 200MG 12/31/9999 20121 24385060173 STAY AWAKE TAB 200MG 12/31/9999 20121 36800040958 STAY AWAKE TAB 200MG 12/31/9999 20121 36800040973 STAY AWAKE TAB 200MG 12/31/9999 20121 49348077103 STAY AWAKE TAB 200MG 12/31/9999 20121 62011000501 STAY AWAKE TAB 200MG 12/31/9999 20121 63868010216 STAY AWAKE TAB 200MG 12/31/9999 20121 51552078606 STEARIC ACID MIS 12/31/9999 20121 38779187709 STEARIC ACID POW 12/31/9999 20121 51552021506 STEARIC ACID POW 12/31/9999 20121 38779163005 STEARYL POW ALCOHOL 12/31/9999 20121 38779163008 STEARYL POW ALCOHOL 12/31/9999 20121 38779163009 STEARYL POW ALCOHOL 12/31/9999 20121 51552041706 STEARYL POW ALCOHOL 12/31/9999 20121 57894006003 STELARA INJ 45MG/0.5 12/31/9999 20121 57894006103 STELARA INJ 90MG/ML 12/31/9999 20121 00264785000 STERIL WATER INJ 12/31/9999 20121 00264785010 STERIL WATER INJ 12/31/9999 20121 00264785020 STERIL WATER INJ 12/31/9999 20121 00264920055 STERIL WATER INJ 08/31/2013 20121 00264920155 STERIL WATER INJ 09/30/2013 20121 00338001304 STERIL WATER INJ 12/31/9999 20121 00338001306 STERIL WATER INJ 12/31/9999 20121 00338001308 STERIL WATER INJ 12/31/9999 20121 00338001329 STERIL WATER INJ 12/31/9999 20121 00409159002 STERIL WATER INJ 12/31/9999 20121 00409404402 STERIL WATER INJ 11/01/2012 20121
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Rebatable Drug List for Iowa Medica
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August 31, 2012 - Iowa Medicaid Enterprise

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